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Park and Kim: Clinical Manifestations and Surgical Outcomes of Intermittent Exotropia with or without Dissociated Vertical Deviation
Original Article
Journal of the Korean Ophthalmological Society

Journal of the Korean Ophthalmological Society 2012; 53(8): 1131-1137.

Published online: 17 August 2012

DOI: https://doi.org/10.3341/jkos.2012.53.8.1131

Clinical Manifestations and Surgical Outcomes of Intermittent Exotropia with or without Dissociated Vertical Deviation

Dae-Young Park, MD, Myung-Mi Kim, MD, PhD

Department of Ophthalmology, Yeungnam University College of Medicine, Daegu, Korea.

Address reprint requests to Myung-Mi Kim, MD, PhD. Department of Ophthalmology, Yeungnam University Medical Center, #170 Hyeonchung-ro, Nam-gu, Daegu 705-717, Korea. Tel: 82-53-620-3441, Fax: 82-53-626-5936, mmk@med.yu.ac.kr

Received 17 October 2011       Accepted 30 June 2012

Copyright © 2012 The Korean Ophthalmological Society

Abstract

Purpose

Clinical manifestations and surgical outcomes of intermittent exotropia with or without dissociated vertical deviation (DVD) were evaluated.

Methods

Patients who were diagnosed with intermittent exotropia following surgical correction were divided into 2 groups: 66 patients with DVD (DVD group) and 81 patients without DVD (XT group). The postoperative deviation between exodeviation of 10 prism diopters (PD) and esotropia of 5 PD was considered surgically successful.

Results

The onset of strabismus occurred at an earlier age in the DVD group. There were more cases of nystagmus, inferior oblique muscle overaction, superior oblique muscle overaction, and AV pattern in the DVD group than in the XT group, but there were no differences between the 2 groups in terms of head tilt, amblyopia, and age at first operation. While exodeviation in the DVD group was smaller than in the XT group, stereopsis in the DVD group was statistically worse than in the XT group in the Titmus test. At postoperative 1 month, the XT group had better surgical outcome, but at postoperative 6 and 12 months, there were no differences in the surgical outcomes of intermittent exotropia between the 2 groups. Regarding DVD surgery, a postoperative DVD angle less than 10 PD accounted for 90.0% of the cases.

Conclusions

Intermittent exotropia combined with DVD had worse stereoacuity and lesser exodeviation. There was no statistically significant difference in the surgical outcomes of intermittent exotropia with or without DVD.

Keywords: Dissociated vertical deviation, Inferior oblique overaction, Intermittent exotropia, Stereoacuity

Figures and Tables

Table 1
Surgical amount table for patients with intermittent exotropia
jkos-53-1131-i001
Table 2
Demographic data of patients
jkos-53-1131-i002

Values are presented as mean ± SD (range) unless otherwise indicated.

DVD = dissociated vertical deviation; PD = prism diopters.

*Intermittent exotropia; †χ2-test; ‡Independent t-test.

Table 3
Comparision of stereoacuity of intermittent exotropia between the groups with/without DVD by Titmus stereotest
jkos-53-1131-i003

Values are presented as number or mean ± SD (range).

DVD = dissociated vertical deviation.

*Intermittent exotropia; †Independent t-test.

Table 4
Distribution of surgery according to the groups
jkos-53-1131-i004

DVD = dissociated vertical deviation; LR = lateral rectus muscle; R&R = unilateral lateral rectus recession and medial rectus resection; SR = superior rectus muscle; IO = inferior oblique muscle.

*Intermittent exotropia.

Table 5
Comparision of success rates of intermittent exotropia operation between the groups with/without DVD
jkos-53-1131-i005

DVD = dissociated vertical deviation.

*-5 Δ<postop deviation <10 Δ; †Intermittent exotropia; ‡χ2-test.

Table 6
One-year postoperative outcomes of dissociated vertical deviation for intermittent exotropia and dissociated vertical deviation surgery
jkos-53-1131-i006

SR = superior rectus muscle; IO = inferior oblique muscle; PD = prism diopters.

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